The Yukon’s health and social services system is “a study in contradictions,” one that works in silos and that, “for too long, has focused on what works for the government and providers.”
That was among the conclusions of an independent panel tasked with reviewing the territory’s heath and social programs and services, a year-and-a-half-long process that culminated in a 204-page final report made public on May 13.
The Putting People First report, dated April 30, contains 76 sweeping recommendations focusing on achieving the “Quadruple Aim” — improving patient experience, improving health outcomes, better managing costs and system effectiveness, and providing better experiences for care providers.
It proposes a “significant shift in the way Yukon’s health and social system works” that would require changes in six key areas: how Yukoners receive care, where the government spends its money, who provides services and how they work together, how providers are compensated, who manages the system and how providers involve clients in making decisions about their care.
“Other, less successful jurisdictions have adopted only some of the elements,” the report says. “The system will not be successful without adopting of all of these critical elements.”
Specific recommendations include creating a new government agency that can cohesively deliver basic health and social services; launching a guaranteed annual income pilot; doubling the territory’s medical travel allowance; creating a separate disability benefit; and implementing “an evidence-based approach to system planning and decision-making.”
The review came out of a recommendation in the Yukon financial advisory panel’s 2017 final report. A five-member independent expert panel chaired by Bruce McLennan, a former deputy minister for the Yukon’s departments of finance, health and social services and education, held public meetings across the territory in 2019 and also met with health care professionals, First Nations and NGOs.
The panel was originally set to deliver its final report to the Yukon government in October 2019. That was then pushed to March 2020, with the government granting another one-month extension on top of that due to the COVID-19 pandemic.
While the Yukon’s system has “real strengths,” including “compassionate and dedicated care providers,” health centres in all communities and a dedicated group of NGOs, it’s also “nestled with significant weaknesses,” according to the report.
“These weaknesses negatively affect the health outcomes of citizens,” the report says.
There’s a lack of communication within the system, the report says, describing various programs and services as working in “silos,” with “no clear links” between health and social services. The Yukon Hospital Corporation, in particular, was singled out as being seen as operating in isolation.
“Overall, our general finding is that despite the small number of players working in the system, they do not do a good job of talking to each other, sharing important and relevant information and putting the needs of clients at the forefront,” the report says.
There’s also a lack of data on social services for the government to base decisions on; for example, with social assistance, there’s no information on why people go on social assistance, how long people stay on social assistance and what other supports people get after going on social assistance.
“Without access to evidence, it is difficult to understand whether programs are meeting the needs of Yukoners,” the report says.
The Yukon’s health and social system is not lacking when it comes to money, the report continues; in fact, the territorial government spends more than $8,000 per person on health each year, which is much higher than the national average. However, this has not necessarily resulted in better outcomes, with life expectancy lower than other parts of Canada and more deaths from preventable causes.
The issue, according to the report, is how and where the money is spent.
“Yukon spends too much on hospitals, long-term care facilities, shelters, fee-for-service payments to physicians and pharmaceuticals,” it says. “It does not spend enough on prevention and keeping people healthy in the first place.”
The territory’s system focuses on diagnosing, treating and managing illnesses, according to the report — an approach that’s working well for some, but not all, Yukoners. The system, it proposes, must shift to a more holistic, “whole-person care” model, one that centres on patients and clients’ wants and needs and is more proactive at addressing factors that can lead to medical issues, including housing, food security and income.
“Taken as a whole, income is one of the most important, if not the most important, determinant of our health,” the report notes, listing 17 recommendations specifically aimed at “closing the gaps” for low-income Yukoners. They include providing funding for NGOs to implement free tax clinics for low-income Yukoners, as well as dental and other extended health benefits to uninsured Yukoners.
Everyone Yukoner should also be connected with either a doctor or nurse practitioner who can serve as a bridge to a larger, integrated health care team, the report says; currently, despite having a high number of family physicians per person, 21 per cent of Yukoners say they don’t have a doctor, compared to a national average of 15 per cent. That, paired with the difficulty of getting a same-day appointment, has led Yukoners to seek non-urgent care at an emergency department instead.
There must also be more partnerships and engagement with Yukon First Nations to ensure programming and service providers can offer a culturally safe and culturally relevant experience, the report says. There’s a lack of Indigenous health care professionals, and nurses coming into communities are not always prepared to work with First Nations patients’ needs; unrealistic expectations have also been placed on First Nations governments to set up on-the-land programs without adequate funding, resources or capacity.
Six recommendations are dedicated to “advancing reconciliation.”
Other recommendations in the report include having the Yukon move from assessing needs at a territorial or individual level to focusing on community initiatives, combining its four different public pharmaceutical benefit programs into one and creating residences in Whitehorse and Vancouver to reduce the need of hotel stays for medical travel.
“Yukon can be a national leader and create a health and social system that is the envy of our country,” the report says.
“We know this requires commitment by Yukoners to challenge the way the current system is organized, by health and social providers to look at their role a little differently, by government to be bold in working with partners to create a new approach to the delivery of health and social services.”
The Yukon’s Minister of Health and Social Services Pauline Frost was not available for an interview before presstime. However, in a press release, Frost said the report contained “bold, progressive recommendations.”
“… I look forward to working with Yukoners as we move ahead with this approach to health and social service delivery in the territory,” she said in the press release.
The panel was expected to present the report at a press conference the afternoon of May 13.
The full report is available here.
Contact Jackie Hong at jackie.hong@yukon-news.com
This story has been updated from a previous version.